The bill would also create an employer mandate. Employers would have to offer insurance to their employees. Employers would have to pay at least a certain percentage (TBD) of the premium, and at least a certain dollar amount (TBD). Any employer that did not would pay a new tax. Again, the amount and structure of the tax is left to the discretion of the Secretaries of Treasury and HHS.
A qualified plan would have to cover “essential health benefits,” as defined by a new Medical Advisory Council (MAC), appointed by the Secretary of Health and Human Services. The MAC would determine what items and services are “essential benefits.” The MAC would have to include items and services in at least the following categories: ambulatory patient services, emergency services, hospitalization, maternity and new born care, medical and surgical, mental health, prescription drugs, rehab and lab services, preventive/wellness services, pediatric services, and anything else the MAC thought appropriate.
Health insurance plans could not charge higher premiums for risky behaviors: “Such rate shall not vary by health status-related factors, … or any other factor not described in paragraph (1).” Smokers, drinkers, drug users, and those in terrible physical shape would all have their premiums subsidized by the healthy.
The bill would expand Medicaid to cover everyone up to 150% of poverty, with the Federal government paying all incremental costs (no State share). This means adding childless adults with income below 150% of the poverty line.
People from 150% of poverty up to 500% (!!) would get their health insurance subsidized (on a sliding scale). If this were in effect in 2009, a family of four with income of $110,000 would get a small subsidy. The bill does not indicate the source of funds to finance these subsidies.
People in high cost areas (e.g., New York City, Boston, South Florida, Chicago, Los Angeles) would get much bigger subsidies than those in low cost areas (e.g., much of the rest of the country, especially in rural areas).
The bill defines an “eligible individual” as “a citizen or national of the United States or an alien lawfully admitted to the United States for permanent residence or an alien lawfully present in the United States.”
The government would mandate not only that you must buy health insurance, but what health insurance counts as “qualifying.”
Health insurance premiums would rise as a result of the law, meaning lower wages.
A government-appointed board would determine what items and services are “essential benefits” that your qualifying plan must cover.
You would find a tremendous new disincentive to switch jobs, because your new health insurance may be subject to the new rules and would therefore be significantly more expensive.
Those who keep themselves healthy would be subsidizing premiums for those with risky or unhealthy behaviors.
Far more than half of all Americans would be eligible for subsidies, but we have not yet been told who would pay the bill.
The Secretaries of Treasury and HHS would have unlimited discretion to impose new taxes on individuals and employers who do not comply with the new mandates.
The Secretary of HHS could mandate that you provide him or her with “any such other information as [he/she] may prescribe.”
Hat tip to Keith Hennessey for breaking this down. He has links to the actual legislation.
If the government goes into competition with the private sector, would there be any reason to companies for provide insurance to employees? How many insurance companies would fold because they can't compete with federally subsidized medical coverage? Are you willing to wait years for a government bureaucrat to decide whether or not you get a procedure or operation? When you go to the doc, and he says before he fixes you, he has to ask the insurance company if he can do it. You think that's stupid and frustrating. Wait until a government bureaucrat has that power.
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